East Lancashire
Intermediate Care
Allocation Team
National Conference
Wednesday, 13th November 2013
East Lancashire Health
Economy - ICAT
• Dr Richard Daly – Clinical Lead for Integrated Care
• Emma Ince – then Locality Commissioning Manager
for East Lancashire, Lancashire County Council
• Vicky Crossley – Intermediate Care Programme lead
and Head of Service for ICAT, East Lancashire
Hospital Trust
• Alex Townsend - ICAT Manager and lead social
worker
East Lancashire Health Economy
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5 Boroughs mixture of urban and rural communities
Population overall: 370,752
78,912 aged 65+
Rank of average Index of Multiple Deprivation Score (2010); districts in
East Lancashire ranges from Burnley 11 to Ribble Valley 290
• 5 Hospitals
– Burnley General Hospital, Royal Blackburn Hospital
– plus 3 Community hospitals
• 31,839 non-elective medical admissions per year
• Readmissions rate 12% (going down)
What we’d like to leave
you with today
• The inspiration, concept and model
• How to set up an ICAT team
• What ICAT means in practice for people in East
Lancashire - case studies
• Lessons learnt and an opportunity to ask further
questions
The inspiration,
concept and
model
A need to change the way
we allocate intermediate*
care
• Data analysis and patient stories told us that
Community Services across health and social care is
fragmented and duplicated causing:
– Poor outcomes and value for those accessing services
& their carers
– Confusion and dissatisfaction for all participants
– Wasted resources and expensive
– £25k average person in residential care compared to
much reduced costs over time if person is at home.
We’ve had case studies of £10k, £5k or even nothing
– A Silo culture approach (my patient/your client)
What we use:
Intermediate Care Provision
Social Care:
√ Residential rehabilitation:
• Olive House – Rossendale
• Castleford – Clitheroe
√ Integrated re-ablement
√ Interim support (packages of
care, short term care)
√ Roving nights
√ Help Direct
√ Crisis Support (72 hours)
√ Telecare, etc.
√ Floating support, welfare rights,
age UK, money management, Help
Direct
√ Falls Team
Health Care:
√ Virtual Ward
√ Community Therapies
√ Domiciliary Medicines Care
√ Falls prevention
√ Continence services
√ Community diabetes services
√ Podiatry
√ Psychological therapies
√ Integrated Community Teams
√ And many, many more….
Part of a larger Transitional
Care Strategy
Unplanned
episode of care
Transfer
of care
function
GP Step up function:
Medical Transitional
Care
Integrated
Neighborhood
Teams
Where ICAT fits in
“ICAT is the fundamental lynchpin of our integration strategy for
all adults in East Lancs”
A multidisciplinary team providing:
• An assessment validation function
• One point of contact
• A mobilization function
• A monitoring function
– Of the patient/service user
– For demand management purposes
• An efficiency measurement function
• A model for integration that we can test and learn
from
• Business case costs (£280k) v opportunity costs
ICAT – an inclusion criteria works
well for access to the service
• 18 years+
• Resident in East Lancashire
• Some intermediate health care provision is
dependant on being registered with an East
Lancashire GP
• Consented to the referral
• Able to participate in short term community based
services
• Medically stable enough to receive support at home
or in a community setting (includes physical and
mental health)
ICAT is used by Professionals
across Community and Acute
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Lancashire County Council/ OCL: Intake (aka The Hub)
Virtual Ward
Community Therapies:
– Occupational Therapy / Speech and Language Therapy /
Physiotherapy
Lancashire County Council – all functions (new and existing service
users)
– Integrated Community Teams & Integrated Respiratory Service
– Community Hospitals (Ward 23 BGH, AVH & CCH)
– DFT/Hospital Wards / A&E / MAU
Coming Soon……
– GPs
– Acute Wards
Agreed set of measures
• 100% of patients to have an integrated assessment
plan
• Reduction in avoidable hospital admissions
• Reduction in residential and nursing home
admissions and high cost support packages
• Reduction in length of stay and lost bed days
• Positive patient/service user staff stories and
evaluation - better outcomes for people
• Community/acute balance - increase in step up
access to intermediate care
• Reduction in inappropriate referrals and duplicate
assessments
How to set up
an ICAT team
ICAT as a project in its first
year
ICAT East Lancashire - Jan 2013
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Establish motivated integrated team and functions 
Developed relationships between health, social care and
providers 
AQuA Integrated Care Communities Programme 2
Review area for re-modelling - early analysis telling us success
requires “our patient whole system approach” 
Established a robust number of referrals and more to come 
Developed understanding of capacity and demand 
No complaints to date 
Transfer of Care across Pennine Health Economy
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Service specification for medical support
Whole system transfer of care model – acute and community
Operationalise ICAT in the wider system (coming soon)
ICAT as a project
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Collaborative project delivery group of all the key
stakeholders – commissioning and providers sharing
the risk
We set three key objectives for the team in this phase:
1. Development of an ICAT service offer
 opening incrementally to referring groups
 sell in real time
 service development group where referrers help
shape their own service
 process development including multi disciplinary
common assessment form
 monitoring systems)
2. Development of a motivated team (recruitment,
team event, development, location)
3. Establishing governance (reporting group, metrics,
CQC, financial monitoring)
ICAT The Team (@£280k per annum +
£25k set up costs)
ICAT STRUCTURE
Acting Head of Commissioning EL
LCC Adult & Community Services
Catriona Logan
Alex Walker
Community Divisional General
Manager ELHT
NHSEL Commissioning Clinical
Group
Victoria Crossley
Intermediate Care Programme
Manager - ELHT
ICAT Manager
Giulia Grieco
Tim Starkey
ELHT
ICAT Co-ordinator
ELHT
Nurse (Band 6)
(On rotation duration TBC)
ELHT
ELHT Allied Health
Professional (rotation)
DFT/ICAT
Facilitator/Progressor
Aneesa Butt
Occupational
Therapist
Band 4
(On rotation)
Nicola Proudfoot
Alex Townsend
Social Worker
Social Worker
LCC
LCC
ICAT Team
Multi Disciplinary Team- Early identification of people
in hospital suitable for intermediate care
Multi disciplinary team - discussing waiting lists, capacity in
residential rehab (Olive House) and community support
requirements
Agreed set of measures
• 100% of patients to have integrated assessment plan
• Reduction in avoidable hospital admissions
• Reduction in residential and nursing home
admissions and high cost support packages
• Reduction in length of stay and lost bed days
• Positive patient/service user staff stories and
evaluation – better outcomes for people
• Community/acute balance – increase in step up
access to intermediate care
• Reduction in inappropriate referrals and duplicate
assessments
Our underlying metrics
• Referrals received against available working days
(600 to date)
• By referring group
• Location of person when referred
• By district where person resides
• By gender, age and ethnicity
• Intermediate care need due to..
Our underlying metrics
• Number of long term conditions – i.e. complex
• Total assessments avoided – social care and nursing
• ICAT selected a different pathway for people
• ICAT commissioned different services for people due
to a lack of capacity (e.g. case for more re-ablement)
• Community bed capacity
What ICAT means
in practice for
people in East
Lancashire
Case Studies
Social Service took all the
details of my
circumstances and
referred me to ICAT.
ICAT felt a period of
residential rehab was
required and I
consented. I moved in to
rehab the next day.
After a couple of days at
home I realised I was not
managing very well. I had
experienced numerous falls
and felt depressed, I wasn’t
eating and I took to my bed.
My daughter rung social
services.
I had recently been
discharge from hospital. I
did not feel I needed any
support for discharge. I
was scared of admitting
that I was becoming
dependent.
My initial rehab goals
were to increase my
confidence, address my
depression, improve my
mobility and increase my
nutritional intake.
Whilst in rehab ICAT
constantly reviewed
my progress with
the Therapy Staff
and Carers that
were looking after
me.
Harry: I am a 92 year old
gentleman. I have lived in
Rossendale all of my life. I have a
diagnosis of early stage
dementia and I have always
been independent and never
needed support.
At the end of my reablement I am now back to how I was
before my hospital admission and managing
independently. I feel much better now. I have linked in
with a local community group and started to make some
new friends. I have a befriender who calls once a week. I
now feel I have something to live for. My daughters feel
as though they have their father back.
From the
information ICAT
received, a number
of recommendations
for my discharge
home were made.
This included
reablement,
medication
management,
volunteer
befriending service,
and help direct to
link me into
community
activities.
Multi- disciplinary transfer of care assessment tool- draft to be implemented
Lessons learnt
and an opportunity
to ask further
questions
Key messages to date
Success factors
• Developed from vision to delivery on a needs-based approach
throughout
• Close personal & organisational collaboration between Health
& Social Care colleagues
• Strong support from strategic and operational leadership is
integral to success
• Allowing a service to naturally grow and having an open
system that people can buy into as they design it
• Engaging a dedicated programme manager to drive the
change
Challenges
• Changing culture in a pressured environment – takes time
• Continuing to keep the message going in a complex and
stretched health system
Not just a concept –
Evidence Base
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Published by the Royal College of Physicians 2013 re: Future Hospital: Care
comes to the patient in the future hospital http://www.rcplondon.ac.uk/pressreleases/care-comes-patient-future-hospital
Ham, Chris. The ten characteristics of the high performing chronic care
system. Health economics, Policy and Law 2010; 5 (1): 71-90 (January
2010)
Wagner, E. (1998). Chronic disease management: what will it take to
improve care fro chronic illness? Effective clinical practice, 1: 2-4.
Singh, D. and C, Ham (2006). Improving Care for people with Long-Term
Conditions: A review of UK and International Framework, Birmingham:
Health Services Management Centre, University of Birmingham, and NHS
institute for innovation and Improvement
Pearson, M. L., S. Y. Wu, J. Schaefer, A. E. Bonomi, S. M. Shortell, P. J.
Mendell, J. A. Marsteller, T. A. Louis, M. Rosen and E. B. Keeler (2005).
Assessing the implementation of the Chronic Care Model in quality
improvement collaboratives, Health Services Research, 40 (4): 978–996.
Crosson, F. J. (2003). Kaiser Permanente: a propensity for partnership, BMJ,
326: 654.
http://www.kingsfund.org.uk/publications/integrated-care-patients-andpopulations-improving-outcomes-working-together
What else would
you like to know?